CBCT assessment of marginal bone loss and pink esthetic outcomes following peri-implant soft tissue augmentation with fascia lata allograft, platelet-rich fibrin, and connective tissue graft: a randomized controlled trial

Abstract

Achieving optimal esthetic integration and maintaining peri-implant bone stability remain key challenges in implant therapy within the anterior maxilla. While subepithelial connective tissue grafts (CTG) are considered the gold standard for soft tissue augmentation, alternative approaches such as platelet-rich fibrin (PRF) and fascia lata allograft (FLA) have been introduced to minimize patient morbidity. This randomized clinical trial aimed to compare the effects of CTG, PRF, and FLA on Pink Esthetic Score (PES) and marginal bone loss (MBL). Twenty-four systemically healthy adults with a thin peri-implant phenotype were randomly allocated into three equal groups: CTG, PRF or FLA (n = 8/group) at the time of implant placement. Pink Esthetic Score (PES) was assessed at the final esthetic follow-up, and Marginal Bone Loss (MBL) was measured radiographically at 6 months. At 6 months, the CTG group demonstrated a slightly higher median PES (12.00) compared to the FLA and PRF groups (both 10.5). Marginal bone loss was highest in the PRF group (1.038 mm), followed by the FLA group (0.613 mm) and the CTG group (0.475 mm). Statistical analysis revealed a significant difference among the groups (p < 0.001). CTG provided the most favorable combined esthetic and radiographic outcome. FLA represents a promising alternative with reduced morbidity and may represent a clinically acceptable substitute when donor site morbidity is a concern. PRF improved esthetic integration but was associated with greater early marginal bone loss and should be considered an adjunct rather than a full replacement for volume-stable grafting. Clinical trial number: The study was registered on (http://www.clinicaltrials.gov: (NCT06219473) on 12/1/2024), and the date of study start was 1/2/2024, and study completion was 01/02/2025).